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This is part 4 in my 5 part series on healthcare in Nicaragua. I did not realize how much I had to say about the different types of conditions in Nica. Since my post started looking more like an essay than a blog post, I have broken it up into a few pieces. Sorry it is such a lengthy one, but I wanted to be sure and discuss all the main healthcare issues seen in the country.

Conditions and Types of Treatment

Now to the fun part…. what kind of conditions did I see and treat.

<Please note that I am going to be vague regarding the patient description to protect the medical information of those individuals.>

1. Infection, infection, infection

The most common illnesses that were seen in the clinic were infections of all sorts. In Nicaragua, especially rural Nicaragua, most infections are bacterial in nature vs. in the USA they tend to be viral. Patients would come in complaining of difficulty breathing, cough, runny nose, or chest heaviness and upon listening to the lungs you would hear consolidation or according to the Nica doctors a “whoosh whoosh” sound. This to them meant infection, most likely pneumonia although they never did the follow-up labs/imaging to check for sure, and the proper treatment was antibiotics, NSAIDs for pain/fever, and vitamins once the infection was over. Most of these were seen in children, but some in adults as well.

Getting ready to see patients in the clinic.

Along the theme of infection includes ones of the stomach or GI tract. Many patients come in with stomach pain, nausea/vomiting, or diarrhea (lots of diarrhea). After providing a stool sample and receiving a blood draw they would return with the results to be interpreted. More often than not patients would either have a high Eosinophil count (leaning towards allergies or parasites) and/or some type of bacterial culture in their stool (often E. Coli). While in the USA bacterial infections of the GI tract are not common, patients in Nica have the deck stacked against them.

The water supply is not purified, so many patients drink un-purified water. Also, the hygiene practices of washing hands and proper bathroom hygiene is not emphasized or even known leading to an increased chance of exposure. Lastly, the food in Nica is grown with un-purified water and washed in it as well contributing to potential exposures. Typically the treatment is an antibiotic, anti-acid (which does not necessarily protect from future infection, but it is a commonly practiced prescription to give for this diagnosis in Nicaragua), possibly a fever reducer or pain relief (Tylenol or Ibuprofen), and vitamins.

Probiotics are not prescribed although this would be protective from future infections. The clinic does not have access to probiotics to prescribe to patients. Also, there was a lack of understanding on the physician’s part regarding healthy/normal gut flora, which could be the result of a communication barrier or lack of this information being widely accepted in Nicaragua.

I was taking a probiotic while in Nicaragua, to help prevent parasite/bacterial colonization in my GI tract by lack of space. The idea behind it is that if I fill up all the space for bacteria to adhere with ‘good’ bacteria that is commonly found in the gut, then the ‘bad’ bacteria that causes infection has no place to hang on to. When I tried to explain that, their response was, why would you take bacteria to avoid infection.

In such a beautiful country there is unfortunately a lack of infrastructure leading to increased incidence of infection and disease.

The last and probably most common infection that was seen in the clinic includes urinary tract, kidney, and vaginal infections. I combine these together, because often women who had one had the others and most of the men that came in with urinary infections they were advancing to kidney infections. These patients most often came in with the chief complaint of “chistata”, which is a local Nicaraguan word that means urinary symptoms or pain. Again the prevalence of urinary tract infections is partially associated with poor hygiene practices (either lack of using toilet paper completely, wiping from back to front, and/or decreased bathing), lack of water intake (with the heat in Nicaragua and the humidity it is easy to become dehydrated, which increases the incidence of vaginal/urinary infections), and lack of condom use or other forms of protection as well as high risk sexual behaviors. These patients would have a UA (urinalysis) done as well as a urine culture (and vaginal discharge culture for female patients). At the visit the doctors would interpret the results of the ‘exam’ and prescribe the appropriate antibiotic based on the type of infection (Bactrim for kidney/urinary or Clindamycin for vaginal). Often for female patients they would prescribe Monostat cream for fungal infections and overgrowth. Also, patients would receive pain medication and vitamins.

Infections are a commonly diagnosed thing in clinics in Nica due to the lack of hygiene, lack of infrastructure for pure water and good food, close living quarters, and lack of sexual protection and high risk sexual behaviors. The common treatment is an antibiotic based on the type of infection (not the bacteria involved but rather the location), pain reliever/fever reducer, and vitamins for after the infection resolves. Main differences between the USA and Nica in the diagnosis and treatment of infections include:

Less emphasis on diagnosing the specific bacteria if it does not change the treatment vs. needing to be as specific as possible due to providing the most effective treatment and decreasing physician liability for incorrect treatment.

Decreased focus of lifestyle factors that contribute and lead to these infections partially due to lack of infrastructure to solve these issues vs. discussion of lifestyle factors with the ability to change them.

Treatment that is focused on resolving the infection, but antiquated information on adjunctive treatments vs. encouraging probiotics and other treatments and therapies that help support the system while it is fighting off the infection.

Antibiotic heavy prescribing vs. antibiotic light prescribing.

Overall the patients in the clinic were all very sick and needed treatment for multiple medical conditions. Other medical conditions that will be discussed in the rest of this blog post include: allergy, chronic kidney disease, anemia and other illnesses.

Doctors, future doctors, and missionaries in front of the clinic.

My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.

I’ll be brief because I have to run this morning and eat breakfast before leaving for the clinic that I am working at in Leon!

Yesterday I got a tour of the city of Managua and had an orientation to the organization that I am working for. It was a day filled with new food, love, information, and a whole lot of Spanish.

One thing of note regarding health, since this is a health blog… There are not a lot of fresh fruit and veggie choices here. I didn’t realize how blessed I am in the states to be able to grab an apple and eat it without worry. Food for thought!

My updates are going to be brief, because I don’t always have Internet service, but I wanted to let you all know that I am officially in Nicaragua. The 7 hours of flying and sitting was no fun, but I got some beautiful pictures of the scenery below.

When I arrived to the airport I followed the line towards customs with a mix of tourists and locals returning home. I made it through and even exchanged money with my limited Spanish. I then must have looked confused, because an employee grabbed my bag and started taking off so obviously I followed. After five minutes of confusion and airports I was being received by two missionaries who were possibly the most friendly and kind people I have ever met as well as (luckily for me) another student who speaks English.

First we went to get dinner at a Nicaraguan fast food joint that’s called Tip Top, which reminded me of KFC with a Nicaraguan flare. Then we were off to see more of the city, stopping down town to see lake Managua and these lighted trees, which are all over town (and have some back story to them). One cotton candy later we were headed to get ice cream! Food is love, so I appreciated it, but my stomach and mind is missing my kale salad from the veggie grill!

Lastly we arrived at my final destination for the night, a local home in Managua, where I will be staying for two days. I hadn’t noticed the humidity or heat until I arrived at this house. As I was exhausted and my Spanish skills were utilized to their entirety yesterday, I called it a night ‘early’ around 11 pm and slowly fell asleep.

Who knows what today will bring, but I know I will be traveling to Leon tomorrow to meet the doctors I am working with and their clinic! I cannot wait! 🙂

As many of you already know I am planning on traveling to Leon, Nicaragua this August for a medical mission trip. While there are many things I have been doing to prepare both physically, mentally, spiritually, and medically… what I want to discuss tonight is travel vaccinations.

On the Centers for Disease Control (CDC) website, there is a handy little travel guide to whatever country you are traveling to (see image below). When I looked up Nicaragua there were several recommended vaccines and other medical tips… one visit to the travel clinic and $500 later I have received a vaccine for Hepatitis A, Tetanus, Diptheria, Pertusis, and I am currently taking an oral Typhus vaccine. I start my chemoprophylaxis for Malaria on Saturday… there is something to look forward to.

Some of you might be thinking to yourselves, but Emma getting vaccines is such an un-Naturopathic thing to do! To that I would say on the contrary… MANY Naturopathic physicians not only believe that vaccines do work, we practice/prescribe/stick to the same vaccination schedule that is recommended to the public by the CDC. Now do all Naturopathic Doctors (NDs) follow this same thought process, absolutely not! In fact some are probably offended right now, but I do (with a small caveat) and I will briefly explain using some principles of Naturopathic Medicine why, without getting into a heavy discussion on Herd Immunity and/or Immunology.

1. First Do No Harm

One of the oldest tenants of all medical practice is to do no harm. We are very lucky to live in a society not plagued with horrible debilitating diseases such as Polio or even Measles. To jeopardize my patients’ and the communities health by not vaccinating due to personal convictions or personal choice, would be against my duties as a physician.

That being said… As a Naturopathic physician I completely understand and respect patient’s choice and their decision to NOT vaccinate. My patient’s have a right to their own personal choice and I will work with them to come up with a vaccination schedule that works both for their wishes and my own duties as a physician or help them find another doctor that can do so.

2. Prevention

Another principle of Naturopathic medicine is to prevent illness if at all possible, both acute and chronic. Vaccines do this! Let’s use technology we already have to continue to strive for better health. I would rather help my patient’s improve their overall health, decrease risk and symptoms and progression of chronic disease, and become the healthiest versions of themselves than treating a disease that already has a cure.

3. Doctor as Teacher

One place where I differ directly from Allopathic medicine is on the delivery and discussion regarding vaccines with my patient’s. I want to help educate my patient’s on the pros and cons of all vaccines (and medicines, supplements, etc. for that matter) that they are subjecting their body to so they can make an informed and comfortable decision that is best for them. Doctors and patients are a team!

Thyphoid cartoon

Those are my raw thoughts that I was contemplating while taking my live capsule of Thyphoid today. Science is great, we should use it in our favor, as long as it is safe and in our best interest.

If you are interested in these topics or others… stay tuned. More pre-mission trip info to come

My name is Emma Petshow and I am a 4th year naturopathic medical student at the National University of Natural Medicine in Portland, OR. For more about myself, check out my bio. This blog is intended for information about preventive health and lifestyle improvement. The information contained on this blog is not to be used as medical advice. For specific medical advice you should consult your physician.

Yesterday was a very meaningful day for me… It was the day I was presented with my white coat. The white coat ceremony is a ritual or tradition in medical school that marks the medical student’s transition from pre-clinical and basic science course work to clinical and patient based learning. At my school it marks my transition from medical student to secondary intern in the clinic!

Our ceremony at NCNM was marked by speeches from faculty and students where they reminded us the import roll that we play as doctors in our patients’ well being and healing. They also compared the white coat to the sweater worn by Mr. Rodger in Mr. Rodger’s Neighborhood stressing the importance of when you put on that white coat, you are creating a safe and healing space for you and your patient.

Being ‘coated’ by my professor, mentor, and friend.

While we didn’t take the Natutopathic Oath quite yet… We recite it at graduation… It was given to us again to remind us of our role and purpose and calling.

Natutopathic Physician’s Oath:

I dedicate myself to the service of humanity as a practitioner of the art and science of Naturopathic medicine.

I will honor my teachers and all who have preserved and developed this knowledge and dedicate myself to supporting the growth and evolution of Naturopathic medicine.

I will endeavor to continually improve my abilities as a healer through study, reflection, and genuine concern for humanity. I will impart knowledge of the advanced healing arts to dedicated colleagues and students.

Through precept, lecture, and example, I will assist and encourage others to strengthen their health, reduce risks for disease, and preserve the health of our planet for ourselves, our families, and future generations.

According to my best ability and judgement, I will use methods of treatment which follow the principles of Naturopathic medicine:

First of all, to do no harm. To act in cooperation with the Healing Power of Nature. To address the fundamental causes of disease. To heal the whole person through individualized treatment. To teach the principles of healthy living and preventive medicine.

I will conduct my life and the practice of Naturopathic health care with vigilance, integrity, and freedom from prejudice. I wil abstain from voluntary acts of injustice and corruption. I will keep confidential whatever I am privileged to witness, whether professionally or privately, that should not be divulged.

With a whole heart, before this gathering of witnesses, as a Doctor of Naturopathic Medicine, I pledge to remain true to this oath.

Thank you all for your support of me through this journey! I am looking forward to seeing patients in the fall and continue to share my journey with you all.

Yesterday in lieu of lifting or cardio… A friend from my medical school and I decided to go on a hike in the Columbia River Gorge, which was gorge-eous (pun intended). We went up the Horsetail Falls trailhead, saw Ponytail falls, went over to Triple Falls, walked and explored the Oneta gorge, and then headed back to the historic Columbia River Highway!

It was a great, hot, day for a hike, but so nice to be out in nature and getting exercise!

Ponytail Falls

Horsetail falls

My charge to all of you is get out in nature, hike, and move more! Good for the mind, body, and soul. 🙂

I have been slightly M.I.A. from here lately due to preparing for exams and coaching my high school track team, but I had to take a break from all that to share with you lovelies my good news…

I passed my clinical entrance exam!

Me with my lovely momma who has been my #1 fan since forever!

What does this mean? It means that I get to enter into clinic as a secondary (lowest doctor on the totem pole) this Fall 2016! Once I know my specific shift dates/times I will update. Either way it is another step to actually doing what I love, practicing medicine and helping others achieve their best state of health.

Thanks for all your support! New content and announcements and more is coming soon… stay tuned 🙂

Please have more enthusiasm than I did in this picture… but seriously after taking pictures for 10 minutes on a random street it’s understandable